The Doctor Himself and the Human Condition by Martin Lloyd-Jones
The subject on which I have been asked to speak raises a matter of the greatest importance. It confronts not only the members of the medical profession and hospital administrators. It concerns everyone. It will be my duty to substantiate such an unqualified statement. In so far as one’s own professional experience is relevant, I am in a position to speak with some confidence. The immediate aspect of the subject before us is that there is today a subtle move to do away with the Church. If it succeeds, will it be for humanity’s good?
THE FUTURE OF THE HOSPITAL
That the question should need to be seriously discussed today in medical circles arises from the fact that it has increasingly become a matter for comment in meetings of doctors and hospital administrators. During May of last year (1968) at a conference of the official representatives of the associations which are concerned with the hospital services, it was said that –
“The hospital model is now the model to which sociologists are gradually turning their attention. … As religious causes have waned and society has been secularised, it is the hospital which has succeeded and taken the place of the Church. … The hospital has had a precarious and clouded history, which is still to be properly written. But, in spite of that history it is now emerging, not as the last refuge for humanity, but as the most important institution of our time.” 
Speaking some months later at a clinical meeting of the British Medical Association in Cheltenham, Lord Todd commented – ‘with the general decline in religious observance the doctor has in some measure taken on the role of confidant formerly exercised by the priest. …’  The hospital has already taken over some of the work of the Church. Is it destined to do so more and more? The accepted notion seems to be that it will do so. My function, therefore, is to ask whether this is desirable or true?
The best way to approach the subject will be to look at it historically. But it is just here that the relevant facts are so often forgotten. It is characteristic of the age in which we live. People make false claims because they either overlook or ignore the facts concerning the past.
The fact is that, in Western Europe at least, it was the Church which founded the hospital. It was Christian people, who out of compassion for the sick and the suffering, felt that something ought to be done. It is very important that we should keep this point before us. It is true that not merely did the Church initiate care for the sick, and in one sense by so doing introduced Medicine, but she performed exactly the same service in the case of both ‘Poor Law relief’ and education. Let us not forget this. Scientific humanism, which has opposed itself to Christianity, has little that is comparable, and it is important that the humanist should also be reminded of his history. This concern about people – physically, mentally and spiritually – has over the centuries shown itself chiefly amongst Christians and in the organized Church. A number of other groups may, and do, talk a lot about doing good. They generally, however, stop at talking!
It is similarly possible to illustrate this characteristic feature in Christian activity from modern history. In the early days of the developing countries, the building of the hospitals (as, for example in Africa and parts of Asia), the building of schools, the providing of rules of public health and much else has originally occurred as the result of the concern and the activity of the Christian Church. Hence, what was true in more remote history has been repeated, especially in the 19th century, in the Church’s great missionary enterprise.
That is how it began. However, as time passed a certain change took place, and these philanthropic functions became separated from their parent. They were, to use the term in the first quotation above, ‘increasingly secularized’. As time passed the practice of medicine, for instance in Europe, was undertaken by individuals who were no longer ordained officers of the Church and who sometimes did not even belong to her. They gradually began to take over the care of the sick, or voluntary bodies began to do so, and, as we know, eventually medical care passed into the hands of the state in a national service.
But, at the present time, we are clearly confronted by a new situation. The Church’s power is waning. The question, therefore that arises is: Can the hospital now take over all the functions of the Church? It has already taken over the medical functions Cannot now the hospital take over all the rest so that the Church may finally complete her atrophy and disappear? My object is to prove that this outcome is one that cannot, and should not, happen.
THE NEED FOR THE CHURCH
How can I demonstrate this negative? Well, in the first instance, I want to show that this idea, that the hospital could take over the remaining functions, rests on a totally false view of the Church. Let me hasten to add, however, that the Church herself is in a large measure responsible for this misconception.
What is this false view? It takes many forms. There are some people to whom the Church is nothing but a part of our national tradition. Church attendance is a part of ‘the thing to do’, and it is still of some social value in these respects. The usual formalities would not be complete without going to a Morning Service, hoping, of course, it will be suitably brief so that one can adjourn to the sherry party as soon as possible. It is all a part of the social round.
Then a somewhat higher view is that the Church is the servant of the state. Her main function is to perform certain things for us. She is useful for a christening, or a marriage or a funeral. The other agencies cannot do that kind of thing quite as well. A Register Office may be all right for legal purposes, but there is something about a Church service which, after all, adds dignity to the occasion. So the Church remains very useful at such times as a marriage, a christening, and, of course, at death. Further, if there happens to be a war and things are not going very well for the nation, then, of course, the Church can organize a national day of prayer.
To move to a higher level, there are a number who believe in the Church because, they say, she exercises a good and general moral influence through her teaching. You need discipline in society they argue, and she really can do very good work in this respect. But, then, some would go even higher still. For, they concede, the Church does after all bring in some kind of vague notion of God and a Supreme Being. It is good, they think, that people should have that!
Passing from such general considerations to the more personal, there are many who would suggest that the main function of the Church is to provide some kind of therapy. They observe that entering a church has a tranquillizing effect and believe that it has a distinct therapeutic value. From the excitement and distractions of the world you are able to go into a building with ‘dim religious light’ and feel a little bit quieter in spirit. Your nerves become more settled and you have a more comfortable feeling. Then there are the various services, well-ordered, well-arranged, and with beautiful singing. All that is good for us. It is a pleasant form of escapism. In addition you will probably hear something about love, kindness, good deeds, and affection. In this turbulent world all these things are therapeutic and promote mental health. This, we are told, is what the Church exists for, and she has done it all very well so far.
To look at the matter still more personally, it has been noted that the Christian ministry has a useful place in the common life. The vicar has certainly had great value in the past, because it has been possible for people to rely upon him for sympathy. He is a man who, because he is thought to have not very much to do, will always be ready to listen to you. Most people like to have somebody who is prepared to listen. Those in trouble are greatly helped by just being allowed to talk, and the vicar or Free Church minister is generally prepared to listen. More than that, he may be able to give some advice or what is now called ‘counselling’. A Roman Catholic can confess his sins to his priest and ‘confession is good for the soul’. The underlying idea is that all this has had a therapeutic value. It has certainly helped people to meet life and its problems.
THE HOSPITAL AS SUBSTITUTE
However, we are now confronted by the new position that people are ceasing to go to church. The question therefore must be put: Can the hospital take over all these functions so that the Church will no longer be necessary? Again, my answer is that such a view can only be based upon a wrong view of the basic functions of the Church. It can only be as a result of an illusion that the hospital can now give these further services – ‘without the “mumbo jumbo”, the ceremonial and all the theological dogma’. Why do I so firmly reject the suggestion that the hospital can be a substitute? I have sought to classify the answers.
I would first query the suggestion of the omnicompetence of the hospital even from the standpoint of fact. This notion is doing a considerable injustice to the doctor of the past, and especially to the general practitioner. It is also granting too much to the Christian minister. Surely, the position has long been that the general practitioner has continually carried out most of the functions that I have been mentioning – apart, of course, from the actual services in a church – more than the minister.
My own personal experience might be brought in at this point. I suppose that the remark which has been made to me more frequently than any other since I have been a minister of religion has been as follows: someone, who has come to consult me, will suddenly add: ‘Of course, I can tell you this because you are a doctor.’ The point I am making is that if I had not been a doctor, it seems, they would not have dared to tell me. This supports my contention that the general practitioner in the past had achieved a kind of father figure. He was the adviser of the family – their guide, philosopher and friend. Most of us can remember this type of general practitioner.
Then, in the second place, I come to a point at which I shall have in a measure to express some criticism of ‘the hospital’ and the medical workers who function in it. This aspect of the subject has its elements of irony in relation to the question we are considering, because I have to spend a good deal of my time, and increasingly so I am sorry to say, in listening to people who complain that the doctors are becoming more and more impersonal and mechanical in their treatment of their patients. I am not manufacturing such evidence; it is something which the lay-public is asserting with greater frankness. They have been given the feeling that they are but guinea-pigs. Things are being done to them by their medical advisers but they themselves have been forgotten as persons.
(a) Poor Communication Another complaint that one often hears and any minister would confirm this very readily – is that the patient ‘cannot get anything out of the doctor’. If they put questions, or ask for explanations, he becomes impatient. He always seems to be too busy; and the patient and the relatives complain that they cannot get any information out of him. Yet, let me remind you, the proposal is that this same doctor should take over the functions of the clergyman and minister, because someone is needed who is ready to listen and to be very sympathetic! It seems to me that the very crisis through which the medical profession itself is passing today answers the suggestion that the hospital should take over the functions of the Church.
(b) Overbusyness The common impression is that the doctor of today is far too busy. This is particularly true, I am told, of the hospital doctor. Indeed, I hear the same thing about the nurses – that nurses nowadays are not nurses in the old sense. They seem now to be semidoctors, very scientific, very learned, very good at giving injections, good at working out doses and much else, but they seem to have lost that ‘motherly’ quality which used to characterize a nurse. The nursing is deficient, whereas the scientific knowledge seems to be increasing. One recognizes that this difficulty must arise as medical and surgical treatment becomes more and more scientific and, also, as the staffing problem becomes increasingly acute. My point is that since the hospital is becoming more impersonal it therefore, of necessity, cannot take over the functions of the Church.
(c) General Practice But someone may say: ‘What about the general practitioner?’ Well, here again, alas, the position would seem to be very much the same. The development of ‘group practices’ means that the patient finds now that he cannot always have the same doctor. This is particularly true at the weekends. His own doctor is only on duty, perhaps, one in every five or six weekends. If some medical emergency were to occur at that time another doctor will often come in, who probably has not seen the patient before and who does not know anything about the case. Here, the personal relationship between doctor and patient is disappearing. In any case the practice of medicine has changed tremendously. In the old days the doctor could and would come in, sit down and have a talk. Nowadays it is a question of form filling, pills, injections, or operations; and it is all done so quickly that the patient is out almost before he is in!
If all this is true, then what I am saying is this – that it seems quite clear that, owing to the present state of medical practice, speaking generally, the hospital is in no position to take over even those functions of the Church to which I have already referred. Moreover, as general practitioners develop the ‘clinic’ idea more and more – and they are doing so – and are less and less disposed to pay what in the United States are called ‘house visits’, then the relationship between doctor and patient is going to become still more impersonal. I argue, therefore, that it will become increasingly impossible for the hospital to take over the functions of the Church.
(iii) The Psychiatrists and Psychotherapy
But I come now to something much more basic. The radical, the third, objection which I have to the proposal is what we already know from the work of the psychiatrist Jung. Even he found that it was almost impossible to help patients, especially over the age of 35, who did not possess some kind of religious background. Psychotherapy alone, he found, could not do what was required. There is certainly a school of thought, which is becoming increasingly prominent in the U.S.A., and also more evident in this country, which claims that psychoanalysis has proved to be more or less useless. It is being asserted more and more that the concept of ‘guilt’ must be restored, if the patient is to be helped. Workers such as O. H. Mowrer increasingly find that from time to time they must call in the Christian minister to help them even in the practice of psychotherapy.
This surely is serious, because the psychiatrists were the medical specialists who earlier claimed that they could particularly help in a personal way, in a way that neither the Church nor anybody else could do. Even they themselves are now found admitting that in a number of cases their therapy cannot do it. Further, there are others who are entirely opposed to the whole notion of what is called ‘Freudianism’. More of the various types of psychiatric condition are being routinely treated by drugs and mechanical procedures. Even in the sphere of psychiatry the doctor-patient relationship is said to be becoming less evident. We hear less about free-association, deep-analysis, and the long interview
But quite apart from recent trends, that branch of treatment was really concerned with one type of patient. It was confined to those who were mentally ill in certain defined ways. In other words, it was only concerned about certain aspects of man’s life and not with the man himself and his basic problem.
THE FUNCTION OF THE CHURCH
Here I come to a fourth argument, which, to me, is the really vital one. What, in fact, is the true function of the Christian Church? It must be considered from two points of view – the primary, essential function of the Church on the one hand, and what may be called the subsidiary ‘by-products’ or ‘incidental functions’ on the other. It is an essential distinction if we wish to keep this subject in due perspective.
Those who are familiar with the New Testament will know that this distinction is something which was very evident in the ministry of the Lord Jesus Christ himself. There were two aspects of his ministry: he came in order primarily ‘to seek and to save that which was lost’. Then there was also his healing ministry and his helping people in other ways.
Christ’s primary purpose and function was neither to heal the sick nor to bring relief in other ways. He certainly did all that, but it was not what he had primarily come to do. The Gospel of John emphasizes this very clearly by referring to his miracles always as ‘signs’. He did these other things because he had a heart of love and of compassion; but he had not come into the world for this purpose. Also, the miracles or ‘signs’ were meant to confirm the fact that he was who he claimed to be. The healing part of his ministry was something that was almost incidental. His primary object was to accomplish something for all mankind, which he alone could do. This is crucial.
What, I say, was true of him in his ministry is equally true of the Christian Church. The authentic task of the Church is not primarily to make people happy; it is not to make people healthy; and it is not even to make people good. The Church, of course, is concerned about making people good, and that they should be happy; yes, but that is not her primary function. This fact is perfectly plain, not only in the Bible itself, but in the great periods of the Christian Church when she really has been functioning fully as the church. Her essential task is to restore men to the right relationship with God.
Hence the real business of the Church is not something which is man-centred. It is God-centred. This is a vital distinction. The hospital and the state can take over many, if not most, of the indirect activities of the Church. But they cannot, and never will, take over the primary function. It is because people have fallen into the habit of substituting the ‘secondary functions’ for the main function of the Church that we have come into all the confusion. There are even many who claim triumphantly that the political parties have also taken over the functions of the Church. It has particularly been so in Wales. During the last century the Welsh Chapels were the centre of the people’s life in almost every respect – cultural, as well as every other. Then a great change took place. The politicians took over, especially the socialists, and they drew away the people from the chapels. This was to a great extent due to the fact that so many of the preachers had become politicians rather than preachers. If you think of the Christian Church – and as a result of the impressions received from the television and radio no doubt many do – as primarily an organization to preach pacifism and socialism, to protest against war and apartheid and other such things, then you are perfectly entitled to say that all this can be done without the Church, and without all that is associated with its life.
THE REAL ISSUE
The basic element in my case is that the Church’s primary function is to restore men to a right relationship with God, and this is something I assert, which only it can ever perform. In the true teaching of the Church, it is man himself who is the central problem. The moment a person realizes this, he also realizes at once that this is something which is true of each individual. I would therefore confront the physician, the surgeon, the psychiatrist, the administrator, or whoever he may be, who proposes that he can take over the Church’s function, with some such reminder as the following. ‘You cannot do so, because you yourself need what the Church alone can supply. You yourself are as much in need as those whom you think you can help. Everybody is in need at this point – it is universal.’
Let me put it in another way. Man’s real problem is not simply that he is sick, but that he is a rebel. Now here again is a crucial distinction. The current notion is that humanity is sick. And of course it is sick, very sick indeed. The real question, however, is: Why is it sick? The basic answer of the Bible and the Church, when she is really preaching the Bible, is that man’s ultimate problem is not the sickness. That is only a symptom, or a complex of symptoms. It is a manifestation of something much deeper and more serious.
The central message of the Church is that man is a rebel against God. All our troubles result from that fact – all of them, without any distinction. It is especially true of those symptoms which are most obvious in the life of the world today. Man has made himself autonomous. He does not recognize anything above and beyond himself. He regards himself as the greatest factor in the universe. You must have read recently of the claim that man is now in a position even to be a ‘creator’. Because man has become autonomous he has inevitably become self-centred, and self-centredness always leads to certain consequences. If I am a ‘god’, nobody must be allowed to reduce my status. But the other man also regards himself as a ‘god’, so that we are both very sensitive about our ‘powers’ and hence we are constantly over-protecting ourselves. This paves the way for jealousy and envy. It also leads to aggressiveness and aggression. All this in turn, of course, leads to overwork. A man aims at a position, then when he has achieved it, he is afraid of losing it, for ‘uneasy lies the head that wears a crown’. And so we overwork, and we become overtired. We become deeply involved in what is known as ‘the rat race’. We begin to feel the strain and here is the central problem of modern society.
In addition to all that, and on another level, there is the undercurrent of lust, desire and passion. It does not matter how scientific a man may be in his work, he is still a man. He has certain primitive instincts within him which are much more powerful than his mind and his will. The fact that anyone is intellectually an able man does not mean that he can control himself and his own passions. All this leads in the long run to over-tiredness, restlessness, a sense of guilt, remorse, and finally a sense of failure. Hence there is the resort to ‘pep pills’, tranquillizers, hypnotics, or an excess of alcohol. It does not matter which of them it is; experience emphasizes that so often it all ends up in a sense of futility, and the despairing question, ‘Is it worth it all?’
PALLIATION OR TREATMENT?
This is the position, and surely Medicine can do nothing about all this except to palliate the symptoms. I am not, of course, suggesting that this is a bad thing to do in itself. It is quite right to do what we can to palliate symptoms, yet with this qualification – that a true diagnosis has already been made. Sometimes it is a very dangerous act to palliate symptoms. If you are confronted by a man in acute pain, say abdominal pain, and you give him a pain-relieving injection without first doing all that is possible to discover the cause, then I suggest that it is bad medicine! Every well-trained medical student and qualified doctor should be in no doubt about it. But, I suggest, that in moral and spiritual matters we are continuing to do just that and on a national scale!
All the palliatives, and all that the hospital can do, and all the medical profession at its best can do in these matters of which we are speaking, is really only to deal with symptoms. They are not able to face up to the real issue. Centuries ago the central diagnosis was surely put, once and for all, by St. Augustine. Having tried many palliatives, he at last came to this crucial conclusion before God: ‘Thou has made us for Thyself, and our hearts are restless until they find their rest in Thee.’ That is the need, surely, of modern man and his society today. The primary function of the Church is radically to deal with that. It is the Church alone which can do so.
THE NATURE OF MAN
We must continue to ask – what basically is Man? It is the teaching of the Bible alone that goes straight to the basic issue. Is he only an animal? Well, if so, what right have you to complain that he is behaving like an animal. He is clearly demonstrating this for you. You should not be surprised, and there is nothing for you to do about it.
But surely, he is not merely an animal. Here we must emphasize the prevailing fallacy. It is overlooked that, in fact, he is a creature who has been made in the ‘image and likeness of God’. There is something about him which transcends everything else in the universe. He is God’s representative in the world. He is what the Bible terms ‘a living soul’. He has within him a longing for ‘an ampler ether, a diviner air’. He has a sense of incompleteness. He has a sense of something bigger and greater than himself. He cannot define it. But deep within him there it is! The Church alone can enlighten him about its nature. It is God! He was made for God and appointed ‘lord of creation’. He does not, however, find his companionship and communion in nature. No, because he is too big for that, and the world at its best cannot satisfy him. It can give him much, but still there remains the void about which we have earlier spoken.
It is the Church alone, I say, that can give the real answer. And the answer is that mankind needs God. Men in general do not recognize this. It is the business of the Church to tell them. A given individual may feel perfectly happy. He may be born with an equable nature – some people are. Just as you can have nice dogs or cats so you can have nice men and women! But there they are, happy up to a point. But the evil day will come. They need to realize the truth about themselves as men, they need to know God. They need something altogether beyond themselves. God has put certain laws into man’s nature, and all his unhappiness finally results from his resisting the law of his nature, that is, from fighting God. We stubbornly object to the claims of the Highest and set ourselves up as petty authorities.
THE GOLDEN RULE
The first part of God’s law for men is: ‘Thou shalt love the Lord thy God with all thy heart, and all thy soul, and all thy mind, and all thy strength.’ The second part is ‘Thou shalt love thy neighbour as thyself (Matt. 22:37-39). There are many who object today, ‘Surely I can love my neighbour as myself without loving God?’ But this is where they go wrong, they cannot. In stating these two aspects of God’s commands, Christ put them in that order because logically it is the inevitable order. To be able to ‘love thy neighbour as thyself’ implies that you have first to achieve a right view of yourself. If you have not that, then love of your neighbour – and experience bears this out – will, of necessity be a very poor thing. Left to ourselves we cannot love in this way. And the natural reaction of most men is – ‘Why should I do it?’ No, the only hope for the community, as well as for the individual, is that we all equally submit ourselves to God, and come to the realization that we are meant to function under him.
The moment a man realizes that he is only a pilgrim in this world, that finally he has to die and to face God, and that there is all eternity before him, his whole outlook on life changes. Immediately the Church is able to tell him that, although for so long he has been so wrong, he can be forgiven. The Church’s central message is the doctrine of forgiveness, based upon the fact that ‘God so loved the world, that he gave his one and only Son, that whoever believes in him shall not perish, but have everlasting life’ (John 3:16). It is the crucial message of the fact of the Son of God’s coming into the world in order to bear our sins and their punishment, to reconcile us to God, and to give us a new birth, a new life and a new outlook. This is not mere theory. The long history of the Church is filled with proofs of it. We can thank God that some of us know something about it in practice. To say that, to teach that, and to bring people to a realization of it – that is the primary function of the Christian Church. She alone can undertake it.
So to sum up, the hospital, quite rightly in my opinion, has taken over the healing of the sick, the healing of the body, and, in a measure, the healing of the mind. The state has also taken over the administration of social relief, education and much else. There is no objection to all this, so long as it is well done. But the moment that hospital or state say that they can take over everything, including the spiritual, and that the Church has become unnecessary, they reveal evidence of their ignorance on the grand scale. They not only fail to discern the true nature of the Church, but reveal a disastrous gap in their understanding of the nature of man himself – themselves included. They fatally neglect the only power that can enable man to function truly, that is, ‘the Gospel of Jesus Christ, because it is the power of God for the salvation of everyone who believes’ (Rom. 1:14-17).
 Part of an address given to the Christian Medical Fellowship at the Royal Commonwealth Society’s Hall on Wednesday, March 19th, 1969.
 Report of a Conference arranged by Associations concerned with The Hospital Service in Great Britain and Northern Ireland, May 14th-15th, 1968 in the Isle of Man. (Private circulation.)
 Lord Todd: Address to the B.M.A., Clinical Meeting, Cheltenham, October 24th, 1968.